Pregnancy and Kidney Transplantation: A Single-Center Experience

Abstract

Objective: The possibility of pregnancy increases with kidney transplantation in patients with chronic kidney disease. However, graft dysfunction, risk of fetal growth retardation, and fetal anomaly should be monitored closely. In this study, renal and obstetric outcomes were analyzed in pregnant kidney recipients who were followed in our center. Methods: We analyzed 140 reproductive-aged patients who underwent renal transplantation between January 2009 and May 2015, and clinical and laboratory data were evaluated retrospectively. Results: Twenty-four patients became pregnant (17.1%). In pregnant group, median age was significantly lower than nonpregnant group (P =.014). The median age of pregnant group at the time of transplantation was also significantly lower than non-pregnant patients (P <.001). The rate of pregnant patients was 66.7% in 18-25 year age group (P =.008). The rate of urinary tract infection in non-pregnant group was higher than pregnant group (P =.03). Live birth rates were 83.3% and 45.8% of those whose birth weight was higher than 2500 g. The increased level of daily urinary proteinuria and the time from diagnosis of renal failure to transplantation had significant effect on pregnancy (odds ratio = 13.81;95% CI: 2.06-92.45; P =.007 and odds ratio = 3.25;95% CI: 1.11-9.48; P =.031, respectively). Low serum creatinine level had significant protective effect (odds ratio = 0.001; 95% CI: 0-0.30, P =.018). The patients in 18-25 age group were 48.39 times more eligible for pregnancy compared to those in >35 age group (odds ratio = 48.39; 95% CI: 1.26-1860.72; P =.037). Rejection episodes were observed in 1 of pregnant women and 11 of non-pregnant women (P >.05). Conclusion: Pregnancy is possible in kidney transplant recipients of reproductive age. Calcineurin inhibitors and azathioprine seem to be safe. Maternal age, low-serum creatinine, and urinary proteinuria affect pregnancy. The close monitoring of renal function and fetal parameters is very important.